Home-based nursing interventions improve knowledge of disease and management in patients with heart failure / Intervenções de enfermagem no domicílio melhoram conhecimento sobre a doença e tratamento em pacientes com insuficiência cardíaca / Intervenciones de enfermería en domicilio mejoran conocimiento sobre la enfermedad y tratamiento en pacientes con insuficiencia cardíaca

OBJECTIVE: to assess patient knowledge of heart failure by home-based measurement of two NOC Nursing Outcomes over a six-month period and correlate mean outcome indicator scores with mean scores of a heart failure Knowledge Questionnaire. METHODS: in this before-and-after study, patients with heart failure received four home visits over a six-month period after hospital discharge. At each home visit, nursing interventions were implemented, NOC outcomes were assessed, and the Knowledge Questionnaire was administered. RESULTS: overall, 23 patients received home visits. Mean indicator scores for the outcome Knowledge: Medication were 2.27±0.14 at home visit 1 and 3.55±0.16 at home visit 4 (P<0.001); and, for the outcome Knowledge: Treatment Regimen, 2.33±0.13 at home visit 1 and 3.59±0.14 at home visit 4 (P<0.001). The correlation between the Knowledge Questionnaire and the Nursing Outcomes Classification scores was strong at home visit 1 (r=0.7, P<0.01), but weak and non significant at visit 4. CONCLUSION: the results show improved patient knowledge of heart failure and a strong correlation between Nursing Outcomes Classification indicator scores and Knowledge Questionnaire scores. The NOC Nursing Outcomes proved effective as knowledge assessment measures when compared with the validated instrument. .

OBJETIVO: verificar o conhecimento dos pacientes sobre insuficiência cardíaca, por meio de dois Resultados de Enfermagem em ambiente domiciliar, durante um seguimento de seis meses e, correlacionar a média dos seus indicadores com um Questionário de Conhecimento sobre insuficiência cardíaca. MÉTODOS: neste estudo tipo antes-depois, pacientes com insuficiência cardíaca receberam quatro visitas domiciliares, durante seis meses, após a alta hospitalar. Em cada visita foram implementadas Intervenções de Enfermagem, mensurados os Resultados e aplicado o Questionário do Conhecimento. RESULTADOS: vinte e três pacientes receberam visitas em domicílio. Na visita um, o Resultado Conhecimento: Medicação obteve média de 2,27±0,14 e na visita quatro, 3,55±0.16 (P<0,001), e o Resultado Conhecimento: Regime Terapêutico 2,33±0,13 na visita um e 3,59±0,14 na visita quatro (P<0,001). A correlação entre o Questionário do Conhecimento e os escores da Classificação dos Resultados de Enfermagem foi de forte magnitude na visita domiciliar um (r=0.7, P<0,01), mas fraca e não significativa na visita quatro. CONCLUSÃO: os resultados indicaram progresso do conhecimento sobre insuficiência cardíaca e correlação forte entre a Classificação dos Resultados de Enfermagem e os escores do Questionário do Conhecimento. A Classificação dos Resultados de Enfermagem mostrou-se efetiva na avaliação do conhecimento quando comparada ao instrumento validado. .

OBJETIVO: verificar el conocimiento de los pacientes sobre insuficiencia cardíaca mediante dos Resultados de Enfermería en ambiente domiciliario durante un seguimiento de seis meses y correlacionar el promedio de sus indicadores con un Cuestionario de Conocimiento sobre insuficiencia cardíaca. MÉTODOS: en este estudio tipo antes-después, pacientes con insuficiencia cardíaca recibieron cuatro visitas en domicilio durante un período de seis meses tras el alta hospitalario. En cada visita fueron implementadas Intervenciones de Enfermería, mensurados los Resultados y aplicado el Cuestionario del Conocimiento. RESULTADOS: veinte y tres pacientes recibieron visitas en domicilio. En la visita 1, el Resultado Conocimiento: Medicación alcanzó promedio de 2,27±0,14 y, en la visita 4 3,55±0.16 (P<0,001), y el Resultado Conocimiento: Régimen Terapéutico 2,33±0,13 en la visita 1 y 3,59±0,14 en la visita 4 (P<0,001). La correlación entre el Cuestionario del Conocimiento y los scores de la Clasificación de los Resultados de Enfermería fue de magnitud fuerte en la visita en domicilio 1 (r=0.7, P<0,01), pero débil y no significativa en la visita 4. CONCLUSIÓN: los resultados indicaron mejora del conocimiento sobre insuficiencia cardíaca y correlación fuerte entre la Clasificación de los Resultados de Enfermería y los scores del Cuestionario del Conocimiento. La Clasificación de los Resultados de Enfermería se mostró efectiva en la evaluación del conocimiento cuando comparados al instrumento validado. .

Aggravation of Hypertriglyceridemia and Acute Pancreatitis in a Bipolar Patient Treated with Quetiapine

Pancreatitis is a very rare adverse effect of quetiapine treatment, with only 5 cases of quetiapine-associated pancreatitis reported in the English literature to date. Herein, we report one patient who developed severe hypertriglyceridemia (>1000 mg/dL) after quetiapine administration, resulting in acute pancreatitis. An analysis of the underlying pathogenic mechanisms and a review of relevant literature are also presented. Clinicians should be aware of the potentially life-threatening metabolic disturbances and/or pancreatitis associated with quetiapine therapy.

Efficacy and safety of atypical antipsychotic drugs (quetiapine, risperidone, aripiprazole and paliperidone) compared with placebo or typical antipsychotic drugs for treating refractory schizophrenia: overview of systematic reviews / Eficácia e segurança dos antipsicóticos atípicos (quetiapina, risperidona, aripiprazol, paliperidona) em comparação com um placebo ou medicamentos antipsicóticos típicos no tratamento da esquizofrenia refratária: overview de revisão sistemática

CONTEXT AND OBJECTIVE: According to some cohort studies, the prevalence of refractory schizophrenia (RS) is 20-40 percent. Our aim was to evaluate the effectiveness and safety of aripiprazole, paliperidone, quetiapine and risperidone for treating RS. METHODS: This was a critical appraisal of Cochrane reviews published in the Cochrane Library, supplemented with reference to more recent randomized controlled trials (RCTs) on RS. The following databases were searched: Medical Literature Analysis and Retrieval System Online (Medline) (1966-2009), Controlled Trials of the Cochrane Collaboration (2009, Issue 2), Embase (Excerpta Medica) (1980-2009), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) (1982-2009). There was no language restriction. Randomized controlled trials, systematic reviews and meta-analyses evaluating atypical antipsychotics for treating RS were included. RESULTS: Seven Cochrane systematic reviews and 10 additional RCTs were included in this review. The data generally showed minor differences between the atypical antipsychotics evaluated and typical antipsychotics, regarding improvement in disease symptoms, despite better adherence to treatment with atypical antipsychotics. Risperidone was specifically evaluated in patients with RS in one of the systematic reviews included, with favorable outcomes, but without definitive superiority compared with other drugs of proven efficacy, like amisulpride, clozapine and olanzapine. CONCLUSIONS: The findings underscore the difficulty in treating these patients, with high dropout rates and treatment patterns of modest improvement in assessments of effectiveness. Atypical antipsychotics have advantages over typical antipsychotics mainly through their better safety profile, which leads to better adherence to treatment. A combination of antipsychotics may also be an option for some refractory patients.

CONTEXTO E OBJETIVO: De acordo com alguns estudos de coorte, a prevalência da esquizofrenia refratária (ER) está entre 20-40 por cento. Nosso objetivo foi avaliar a efetividade e segurança de aripiprazol, paliperidona, quetiapina e risperidona no tratamento da esquizofrenia refratária. MÉTODOS: Avaliação crítica das revisões Cochrane publicadas na Biblioteca Cochrane e complementação com referências de ensaios clínicos randomizados (ECRs) mais atualizados sobre ER. As seguintes bases de dados foram pesquisadas: Medline (Medical Literature Analysis and Retrieval System Online) (1966-2009), Ensaios Controlados da Colaboração Cochrane (2009, edição 2), Embase (Excerpta Database) (1980-2009), Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde) (1982-2009). Não houve restrição a idiomas. Ensaios clínicos randomizados, revisões sistemáticas e metanálises que avaliaram antipsicóticos atípicos no tratamento da esquizofrenia refratária foram incluídos. RESULTADOS: Sete revisões sistemáticas Cochrane e 10 ECRs complementares foram incluídos nessa revisão. No geral os dados demonstram pequenas diferenças entre os antipsicóticos atípicos avaliados e os típicos na melhora dos sintomas da doença, apesar da melhor adesão ao tratamento com os atípicos. A risperidona foi avaliada especificamente em pacientes com esquizofrenia refratária em uma das revisões sistemáticas incluídas, a qual demonstrou desfechos favoráveis, porém não definitivos quando comparada a drogas também com eficácia comprovada como amisulprida, clozapina e olanzapina. CONCLUSÕES: Os dados reforçam a dificuldade de tratar esses pacientes, com elevadas taxas de desistência do tratamento e padrões de melhora modestos nas avaliações de eficácia. Os antipsicóticos atípicos têm vantagens sobre os típicos principalmente pelo melhor perfil de segurança, o que leva a melhor adesão ao tratamento. A associação de antipsicóticos também pode ser uma opção em alguns pacientes refratários ao tratamento.

Quetiapine for the prevention of migraine refractory to the combination of atenolol + nortriptyline + flunarizine: an open pilot study / Quetiapina para a prevenção da migrânea refratária à combinação de atenolol + nortriptilina + flunarizina: estudo piloto aberto

BACKGROUND: Migraine is a prevalent neurological disorder. Although prevention is the mainstream treatment, some patients are refractory to standard therapies. AIM: To evaluate the use of quetiapine (QTP) in the preventive treatment of refractory migraine, defined as previous unresponsiveness to the combination atenolol + nortriptyline + flunarizine. METHOD: Thirty-four consecutive patients (30 women and 4 men) with migraine (ICHD-II) and headache attacks on less than 15 days per month not overusing symptomatic medications were studied. The main inclusion criterion was the lack of response (<50 percent reduction in attack frequency) after ten weeks to the combination of atenolol (60 mg/day) + nortriptyline (25 mg/day) + flunarizine (3 mg/day). The patients started on QTP as the sole treatment in a single daily dose of 25 mg, titrated to 75 mg. After ten weeks, headache frequency, consumption of rescue medications and adverse events were analyzed. RESULTS: Twenty nine patients completed the study. Among completers, 22 (75.9 percent; 64.7 percent of the intention-to-treat population) presented >50 percent headache reduction. The mean frequency of migraine days decreased from 10.2 to 6.2 and the average consumption of rescue medications decreased from 2.3 to 1.2 days/week. Adverse events were reported by 9 (31 percent) patients. CONCLUSION: Although limited by the open design, this study provides a pilot data to support the use of quetiapine in preventive treatment of refractory migraine.

INTRODUÇÃO: A migrânea é uma doença neurológica prevalente. Embora a prevenção seja o esteio principal do tratamento, alguns pacientes são refratários aos tratamentos tradicionais. OBJETIVO: Avaliar o uso da quetiapina (QTP) no tratamento preventivo da migrânea refratária definida como ausência de resposta ao uso prévio da combinação de atenolol com nortriptilina e flunarizina. MÉTODO: Trinta e quatro pacientes consecutivos (30 mulheres e 4 homens) com migrânea (CIC-II) e crises de cefaléia em menos de 15 dias/mês sem uso excessivo de sintomáticos foram estudados. O critério de inclusão principal foi a não obtenção na redução da frequência de cefaléia >50 por cento após 10 semanas de uso da combinação de atenolol (60 mg/dia) + nortriptilina (25 mg/dia) + flunarizina (3 mg/dia). Os pacientes iniciaram a QTP como tratamento único na dose de 25 mg à noite e aumentaram-na até 75 mg. Após 10 semanas de uso, a frequência da cefaléia, o consumo de sintomáticos e os efeitos colaterais foram avaliados. RESULTADOS: Vinte e nove pacientes completaram o estudo. Entre os que completaram, 22 (75.9 por cento; 64.7 por cento dos pacientes que foram incluídos) obtiveram redução da frequência >50 por cento. A frequência média de dias com migrânea por mês decresceu de 10,2 para 6,2. O consumo médio de sintomáticos caiu de 2,3 para 1,2 dias/semana. Efeitos colaterais foram relatados por 9 (31 por cento) pacientes. CONCLUSÃO: Apesar de limitado pela metodologia aberta, esse estudo oferece dados iniciais para a possível utilidade da QTP na prevenção da migrânea refratária.

Prescripción de antipsicóticos atípicos en pacientes hospitalizados de la Clínica Psiquiátrica Universitaria / Prescription of atypical antipsychotic drugs for inpatients at a university psychiatric clinic

Introduction: During the past few years, several new generation antipsychotic drugs have been incorporated in our country. However, the manner in which these drugs are actually used by our clinicians has been poorly documented until now. This study aims to characterize the prescription pattern of antipsychotic drugs for inpatients at a Chilean psychiatric institution. Methods: We carried out a retrospective study using clinical records of inpatients at the University of Chile Psychiatric Clinic between May and September 2005. We registered every antipsychotic drug used and its dosage for every diagnosis, including whether it was prescribed as permanent or as PRN. Results: During this period there were 246 hospital discharges and some kind of antipsychotic drug was used in 80 percent of cases. The main diagnoses associated with the use of antipsychotic drugs were schizophrenia, exogenous psychosis and bipolar disorder, but they were also used frequently in other diseases such as eating disorders, personality disorders, and unipolar depression. A typical antipsychotic drugs were the most frequently used, whether alone or in PRN combination with a neuroleptic drug. Among atypical antipsychotics, the most frequently prescribed were risperidone (41 percent) and quetiapine (34 percent). The dosage used was widely different depending on the diagnosis. Conclusion: Antipsychotic drugs, particularly atypical ones, are broadly used in the treatment of inpatients with several psychiatric disorders

Introducción: En los últimos años se han incorporado al medio nacional diversos antipsicóticos de nueva generación, pero el modo de utilización practica por los clínicos ha sido poco documentada. El objetivo de este estudio es caracterizar el patrón de prescripción de los antipsicóticos en pacientes hospitalizados en una institución psiquiátrica nacional. Métodos: Se estudió retrospectivamente las historias clínicas de los pacientes hospitalizados en la Clínica Psiquiátrica Universitaria entre Marzo y Septiembre de 2005. Se registraron los diversos antipsicóticos empleados y sus dosis para cada diagnóstico, tanto como indicación de uso permanente o esporádico. Resultados: En el período estudiado hubo 246 egresos y se empleó algún antipsicótico en el 80 por ciento de los casos. Su principal indicación fue en esquizofrenia, psicosis exógena y trastorno bipolar, pero también fueron utilizados con frecuencia en otros cuadros como en trastornos de la alimentación, de la personalidad y en depresión monopolar. Los más empleados fueron los antipsicóticos atípicos, solos o asociados con un neuroléptico de uso esporádico. Los antipsicóticos atípicos más prescritos fueron risperidona (41 por ciento) y quetiapina (34 por ciento). Las dosis utilizadas variaron ampliamente según los diversos diagnósticos. Conclusiones: Los antipsicóticos, en especial los atípicos, son ampliamente utilizados en el tratamiento de diversas patologías psiquiátricas en pacientes hospitalizados

Quetiapine for tic disorder: a case report.

Tic disorders happen in nearly 20 per cent of children. There is no "best drug" to treat this illness. Potent antipsychotics e.g. haloperidol and pimozide, are the most effective drugs but their limitations are their extrapyramidal side effects (EPS). Risperidone has been proved on efficacy for tic disorders but EPS still remain, even though it was claimed to be less. Thus, quetiapine, a newer atypical neuroleptic with the same action as risperidone and produces fewer EPS, was included in this study. OBJECTIVE: To study the efficacy and side effects of quetiapine in tic disorders. METHOD: A case report of a 19-year-old female patient with tic disorder who had taken haloperidol 2 mg/d with benzhexol HCl 2-4 mg/d, then switched to risperidone 1.5 mg/d with benzhexol HCl 4 mg/d because of acute dystonia and oculogyric. She was then prescribed quetiapine, 50 mg/d as a starting dose without benzhexol HCI, because of the remaining symptoms and EPS. The severity of the symptoms was assessed monthly using the Behavior Rating Scale. The dose was increased by 50 mg/d weekly for a better outcome. RESULTS: The tic was improved after the first week and disappeared for three weeks with 150 mg/d of quetiapine. However, the tic returned again, but less frequently (20%). Thus, the dose was stepped up to 200 mg/d. One week later, the patient reported that the tic has disappeared. CONCLUSION: Quetiapine showed the efficacy and fewest EPS in this patient. However, a further clinically controlled trial must be carried out before quetiapine can become the first-line treatment for tic disorders.

Comparison of the efficacy and acceptability of atypical antipsychotic drugs: a meta-analysis of randomized, placebo-controlled trials.

Knowing the clinical differences of olanzapine, quetiapine, and risperidone would be of benefit for choosing an atypical antipsychotic drug. In order to compare their efficacy and acceptability, we conducted a meta-analysis of published, randomized, placebo-controlled trials by comparing the response and dropout rates of an atypical antipsychotic drug group and those of a placebo group. After a comprehensive search of study reports, the response and dropout rates of patients treated with an atypical antipsychotic drug and those treated with placebo were extracted on the intention-to-treat basis. The effect size with 95 per cent confidence interval (CI) of pooled data comparing the response and dropout rates of an atypical antipsychotic drug group and those of a placebo group were calculated by using the Peto method. The response-rate effect sizes (95% CIs) of olanzapine, quetiapine, and risperidone were 1.75 (1.06 to 2.89), 1.71 (1.20 to 2.42), and 3.28 (1.98 to 5.44), respectively. The dropout-rate effect sizes (95% CIs) of olanzapine, quetiapine, and risperidone were 0.55 (0.35 to 0.88), 0.65 (0.46 to 0.91), and 0.39 (0.24 to 0.62), respectively. In conclusion, olanzapine, quetiapine, and risperidone are more effective and more acceptable than placebo in treating schizophrenic patients. However, they are not different from each other in the respect of efficacy and acceptability. The cost of these agents should play an important role in choosing an atypical antipsychotic drug.